Tuesday, September 8, 2009

CBO's Quality Study

The Congressional Budget Office’s (CBO) study “Quality Initiatives Undertaken by the Veterans Health Administration (VHA)” published August 2009, discusses the VHA’s experience with not only quality improvement but also with health information technology.

Many of VHA’s quality improvement programs use data from computerized clinical records to track both process and outcome measures, including risk-adjusted mortality and morbidity. These programs have helped VHA recognize problems in specific healthcare facilities as well as to improve performance throughout the agency.

According to the report, one of the major problems that the VA has in dealing with vast amounts of information is the fact that many veterans receive care outside of the VHA system and as a result, the exchange of information is more difficult to achieve. The VHA has made some progress in exchanging patients’ healthcare information with the military health system, but the exchange of data between VHA and private providers still lags behind because of incompatible data structures and a lack of data-sharing agreements.

In addition, when patients are enrolled in both Medicare and VHA they will choose the program for care depending on the type of medical services that they need at the time. For example, few enrollees rely on VHA for outpatient surgery services but a large fraction of those patients seeking outpatient substance abuse treatment turn to the VHA for that type of care.

The study summarizes the VHA programs in place that are designed to improve the quality of care and this includes:

• VistA plays a key role in the agency’s efforts to measure performance and improve quality. Researchers have used clinical data in VistA’s EHR to study the effects of various quality improvement strategies
• An Internal Clinical Peer Review program is in place at each hospital
• An External Peer Review Program extracts data from patient care records in VHA’s clinical systems and then compares the information with evidence-based performance criteria
• A National Surgical Quality Improvement Program is in place that enables risk-adjusted comparisons of surgical outcomes to be made to identify surgical units with unexpectedly high or low rates of morbidity or mortality
• An Inpatient Evaluation Center is designed to improve outcomes in the acute care hospital setting by examining data from EHRs
• A set of programs in the Quality Enhancement Research Initiative aims to put clinical research findings and evidence-based recommendations into clinical practice
• An Evidence-based Synthesis Program systematically reviews published research on medical issues of particular importance to VHA’s user population

To download the report, go to www.cbo.gov then click on recent reports.